EBB 136 – Solutions for the Crisis in American Maternity Care with Jennie Joseph

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Rebecca Dekker:

Hi, everyone. On today’s podcast, we’re going to talk with Jennie Joseph about solutions for the crisis in American maternity care.

Today, I am so excited to welcome Jennie Joseph to the Evidence Based Birth® podcast. Jennie Joseph is one of the world’s most respected midwives and authorities on women’s health, healthy pregnancies, healthy deliveries, and healthy babies.

She’s a true advocate for systematic reform that puts families first in health care. Jennie is the founder and executive director of Commonsense Childbirth Inc, and the creator of The JJ Way®, a commonsense approach designed for women and children. After training as a British midwife, Jennie moved to the United States and began a journey that culminated in the formation of an innovative maternal child health care system, which markedly improves birth outcomes for thousands of women and children in the US. Jennie has worked in European hospitals, American birth centers, clinics, and home birth environments. She’s been instrumental in the regulation of Florida midwives. She’s the former chair of Florida State Council of Licensed Midwives.

And currently, Jennie owns a Florida licensed midwifery school named the Commonsense Childbirth School of Midwifery, and that is run in conjunction with The Birth Place, which is a world-renowned birth center in Winter Garden, Florida. Jennie speaks all around the world to doctors, and other practitioners, policymakers, and members of the US Congress, including testifying at congressional briefings on Capitol Hill.

And we are honored that Jennie is here today to talk with us about solutions for the crisis in American maternity care. Welcome Jennie to the Evidence Based Birth® podcast.

Jennie Joseph:

Thank you so much, Rebecca. It’s truly an honor. I’m very excited to be here. Looking forward to this conversation.

Rebecca Dekker:

Can you tell our audience, why did you decide to become a midwife?

Jennie Joseph:

I didn’t decide. It was a calling. It was absolutely clear that that was the path, but I didn’t even really know what it was. I was 16 years old. In Europe, we graduate at 16 so everyone, my advisors, career teachers were saying, “Oh, secretary for you, or maybe teacher, but stop this nonsense. What are you talking about, midwife?”

And I didn’t want to be a nurse. And I knew that just as clearly as I knew that I wanted to be a midwife. So, they were hard put to figure out what to do with me. I was very blessed. I was lucky to find a program for direct entry midwives in 1979. It was a pilot program that the British National Health Service was running to see what it would be like to train midwives who were not already nurses.

And so, I was part of that training. I was the only graduate of my class. And I was a hospital-trained direct-entry midwife. And that’s where it all began. But it was absolutely clear to me that I was going to do this work. And I’ve been doing it now. I’ve been involved since 1979. So, I’m on my 40th year doing this work.

Rebecca Dekker:

Do you remember what called you into the field of midwifery or when you first noticed that calling?

Jennie Joseph:

I was 16 and it was as strong and as clear, it was such a passion. But I had no experience. I hadn’t seen the midwife. I had never worked with the midwife. Hospitals always had midwives. Because in Europe and most of the rest of the world, midwives take care of maternity care for populations.

And physicians, obstetricians take care of high-risk women. So, I knew that midwives delivered babies, but that’s about it. But it was such a colon that I literally aggravated the training hospital to let me in at 19. The entry age was 20. But I got in a year ahead because I wouldn’t stop, and I waited.

I did a little work around child development and child health, but it wasn’t for me. I knew that too. So, it was just strong knowing that it wasn’t where I was going as far as child pediatrics. It was definitely midwifery, and I still have that feeling. It will go away. Believe me, I would like to stop at this point, but no, not possible.

Rebecca Dekker:

That is inspirational because sometimes, I even worry, “Will I get tired of birth?” But so far, not yet.

Jennie Joseph:

No, no. No, you will not. If you have the bog, you cannot get any doula, any childbirth educator, lactation educator. Once you’ve been bitten, you will not be able to shake it. It will never leave you. It will always call you back.

Rebecca Dekker:

Wow. So, you were trained in Great Britain, then?

Jennie Joseph:

Yes. I trained in London. And again, it was a part of the program, and I was attached to a very busy hospital in the suburbs of London, and was quite the phenomenon because we were the first of our ilk who were not already hospital mind. So, the three-year training that we had, we had to do some nursing as base work.

So, initially, we did do general nursing, and then transformed very quickly into the midwifery floors. And most of our training was actually on the floor in a practical nurse approach, if you will. And we broke for a few weeks every now and again for didactic, but it was on the floor on the ground. And I always looked very young.

I remember distinctly, the mothers would be very annoyed and horrified. Go get the midwife. You’re not the midwife, obviously. Go get the midwife. And so, I had a lot of that because I look so young, and I was so immature. I really was very silly. I had no clue. And it wasn’t until I had my own son five years later that I realized, “Oh my gosh, it really does make a difference if you know what you’re talking about.”

But I loved it so much. And I was very blessed to be able to get a lot of hands-on experience. And the maturity came in understanding that the women that I was serving have a lot to teach me. That’s how I morphed into being a useful midwife versus just a crazy passionate fool who just had to be in the birth room. There was a transition at some point in my mid-20s. And after I had my own child.

Rebecca Dekker:

So, what was it like then going from a place where it was very much centered around the midwifery model of care, and then you move to the United States in 1989, what did you notice right away that was different about how we care for families during pregnancy and childbirth here?

Jennie Joseph:

Well, I would be honest. I was totally blindsided. I did not do any research. I didn’t stop to look into, “Oh, what are my prospects? What shall I do when I arrive?” I came to be married, and I was married and settled in Orlando, and I was, “Oh, I’m just going to go off, and apply to hospitals, and get a job because American women have babies, so obviously they have midwives.”

And in 1989, it’s not long ago truly, 31 years ago, but it was a complete shock to here, first of all, the response was typically, “What are you talking about? Midwife? What is that? We don’t do that. That’s old school.” So, having left you know thriving midwife communities and midwifery systems, I was very surprised, and taken aback, a bit offended.

And also, clearly put in my place. I was told no, you’re not the one, you don’t even have a registered nurse degree, get away, go back to school start from scratch. And so, it was my own personal sense of being abandoned, almost. My career path at that point, I’ve been a midwife for 10 years, my ability to function and who I was, again, I’ve done nothing else ever in my adult life.

And so, I was just bereft, I was stuck with this, “Well, what am I supposed to do now?” And then, the other side, yes. The question that you’ve asked me, which is how I felt about what the families were enduring. I was horrified. I could see all around me what appeared to me to be horrendous human rights, and egregious behaviors that was so ridiculous.

And I was like, “How is it that I’m in literally Disneyland, Disney World?” The world that the American dream supposedly, it’s all here. And then, of course, another person experience really woke me up. Within a year, I was seeing an OBGYN for endometriosis, which I’ve suffered from most of my adult life as well.

And within a year after a second opinion, I was taken down for hysterectomies, without understanding and recognizing that this physician was also going to take my ovaries. I was 30 years old. So, within a year of blinding in the United States, my world just turned upside down.

And again, I was so horrified with what I was facing because I think you hear these days when we’ve got the COVID-19 pandemic and all these things that are happening. You hear the word dystopia and that these things are so weird. To me, I’ve been there since I got off that plane. I cannot yet understand or fathom how this is acceptable, condoned, a way of being.

I am constantly struggling with the medical industrial complex, racism, classism, sexism, the power dynamics, and the inequity, the inability to shift the ways of being that have grown through, I guess really generations at this point of monopolizing women and birth, monopolizing midwifery, and medicalizing, and really capitalizing on the process of pregnancy, birth and postpartum.

I know that’s a whole mouthful, but this is how hard it is for me, still to this moment. Just you pose the question and off I go, I’m transported back into this place of just fury, and frustration, and it’s hard. It’s hard to swallow that. It’s hard to be constantly having to figure a way to mitigate that. Not only for myself, but for my family, my loved ones, my friends, and my clients, my patients on a daily basis.

Something will remind me of where I am, and how I am, and how it is, and why it is. And then, on top of that, we still have to try to find a way to create safety, respect, and dignity while providing what is normal midwifery care for people who ask for that service.

Rebecca Dekker:

Wow. I’m thinking back to one of the words you use, which I heard recently, and learned this term from listening to other black midwives, and that is the phrase medical industrial complex or MIC. Could you explain for our listeners what the concept of that is?

Jennie Joseph:

Yes. So, I guess it’s really a nod to the capitalism, the power of money, and the impact that looking for that dollar. The bottom line has on making policies, and creating ways that basically condone misbehavior in pursuit of that bottom line. So, that terminology industrial complex, it could be applied to prison, the prison industrial complex.

Building prisons, and putting people into prisons on arbitrary, and just ridiculous charges, but to get the industry, prisons supported. So, we can go back to slavery, we can go all the way back, and look at what has happened historically, in that black bodies, and indigenous bodies have been the witches, if you will, of the industry.

From whether it’s experimentation, from whether it’s just utilizing the bodies for gain, creating, in a way these awful and egregious is the word that keeps coming up, ways of being in order to fulfill an ability to earn money. So, I could make a modern correlation for you. Cesarean sections, oh, we all throw our hands up, and we’re just horrified that we’ve got to this point of one, increased cesareans in the United States as a matter of course.

That is a normal, everyday occurrence at this point. Yes, it might be improving slightly, but it’s basically still there, and it has been for decades. How did we get there? Well, we got there because at the end of the day, bottom line, money. In figuring out that more money was to be made, more power was to be had, more control was able to be evoked onto the system that cesarean is the best solution ever to obstetrics.

Because everybody wins supposedly. If we ignore the woman, and her needs, and her health, and her safety, then everybody wins because physician providers can control birth, which is always a goal. They can be reimbursed accordingly, which is also always a goal. They can reinforce the notion that birth is dangerous, birth is tricky, birth needs technicians, birth needs these kinds of knowledge bases that are going to be lucrative.

Cesareans didn’t just happen to be a thing in America by accident. Part of the medical industrial complex is how do you make your hospital, or your system, or your practice grow? The goal is to make money. So, another example would be how we do insurance claims. How is it that whichever arbitrary price is put on a procedure, or a technique changes according to who’s the recipient of same procedure or technique?

How is it that if you have a patient who’s insured, and you do a cesarean for her, that you get more money because she has a certain type of insurance than if you do a cesarean for someone else, and you get less money for the same exact procedure?

So, the depth and the structural ways that have been embedded to make sure that again, money, bottom line is what’s taken care of, everyone else joins in from a place of well, this is the system we’ve got, or this is the system we’ve inherited, or we don’t have any other way, or it’s not going to work because it’s dangerous, or whatever, whatever, whatever.

Let’s look around the rest of the entire world. In many under resourced countries, where there is such a shortage of obstetricians, there are nurse practitioners, even medical assistants performing cesareans, where women survive and babies survive in dire straits when there’s nobody else to do it at very much more reasonable cost.

At much more tentative approaches, or we’re not going to do the less we get to that absolutely necessary life and death place. All of these things are part of looking at the financial perverse incentives that are embedded into obstetrical care in the United States. So, we all know that obstetrics is one of the most lucrative sides of medicine.

Certainly, for hospital systems, it maintains many hospital systems. Obstetric and neonatal medicine. How interesting then, that the people that suffer most at the hands of those two systems are people of color, people of low income, people who are marginalized?

Rebecca Dekker:

I think you raise a great point about the neonatal systems. I personally know of a researcher who implemented a system at a large hospital that drastically decreased their NICU admissions through reducing preterm birth in the hospital, specifically after the research grant was funded, decided not to continue with that program because it reduced their admissions by too much.

Jennie Joseph:

And so, when I say dystopia, this is the thing I’m talking about because that’s okay. There’s a handful of folks that might have checked themselves and say, “Hmm, but never mind.” Not enough to actually say, “You must be kidding. What’s wrong with you? Do you not understand what the research just showed you? Why are we not following the evidence?”

No one is really going to go to that level because you don’t mess with the medical industrial complex. Hospitals, especially large hospital, regional hospitals, tertiary care hospitals, they’re dependent on the NICU. The NICU must remain full at all costs because otherwise, the hospital cannot thrive. New hospitals that are built, the big dilemma is always, shall we put in NICU or shall we not?

Can we afford to put a NICU? Will we get enough babies delivered to put in that same NICU? These are not these to make decisions if you have a care about humanity. So, we already know whether we want to accept and acknowledge it. Just like with racism, whether we want to accept or acknowledge it. This is what is driving everything.

These behaviors are acceptable and condoned. They are policies. They are all kinds of deep ways, the public health support for the crazy is rife. The researchers and industrial complex, how many more studies do you need to do? And just as you mentioned, when you do want that shows something that you really don’t want to see, quash it real quick.

So, studies which are biased, we need to decolonize research, just as much as we need to decolonize schools. Any and everywhere that you can see structural, racist, classist, sexist behaviors, and policies, procedures, ways of being, all of those show you exactly why we have what we have. So, it’s disingenuous to run around throwing our hands up.

We don’t we don’t know. We need to do some more research. No, we don’t. We really don’t. Yes, it wouldn’t hurt to do some really useful research, and then act on that evidence. But we’re not interested in acting on the evidence. We’re interested in spending the money to maintain the getting off so we can have another run of conferences, and papers, and publishing, and blah-blah-blah.

All of these things that, and please don’t get me wrong. Yes, I’m as upset and mad, but it’s not about blame. It’s about just, can we get to reality? When are we going to go there? And why is it that we find ourselves in this particular country? This, the richest nation in the entire world, this, the most resourced nation in the entire world. Why do we choose to not go that way?

What is it about this country? And it does come down to money, it comes down to capitalism. We might count that under the freedom, and all these different ways of being that we say are what makes America great, and what is America is all about. Except, for if you really want to look at the truth about it, nothing much that we do is equitable, is towards the Bill of Rights, is towards that constitutional ability to the pursuit of happiness. All of these things don’t make a lot of sense.

Rebecca Dekker:

They make a lot of people rich at the top.

Jennie Joseph:

Yes. And that’s why we all strive because we’re going to get there soon one day, except for those of us that are not allowed to get up there because we are faulted at every turn. And so, when we talk about obstetrics, we talk about it from a perspective of, oh, let’s divide this between natural birth, and independent birth, and physiological birth, and the opposite.

But in actuality, we aren’t interested in equity in birth either. Because otherwise, we would not be putting up with this nonsense. We would not be able to condone and let this be. We could not devolve into such a situation that one in three women have a scar in their belly because they live on this particular body of land. These kinds of things are where my dystopia, this is where I’m stuck.

Rebecca Dekker:

You’re living in a dystopian novel-

Jennie Joseph:

I must be. I surely must be because none of it makes sense. And again, 30 years later, I am still struggling on so many levels. And it’s not to say there isn’t any hope, but I find it very hard sometimes to pull hope out of this morass. I’m lost. Where do you begin? And then, the other side of it is also, how do we fight? How do you go against such large systems? And what do we have as our weapons towards dismantling? What are the tools that we can use? Where is the political will or interest? Who are we fighting for?

Rebecca Dekker:

Those are all really important questions. One of the ways that I know that is a solution is midwifery care, and especially black midwives in this country. Can you talk to us about what inspired you to start your birth center?

Jennie Joseph:

Well, yes. It was definitely my recovering from that initial shock in 1989, 1990. Post-surgery, post my own surgery, when I realized what had happened that I was essentially castrated at 30 years of age. I was placed on back then, you may remember there was a drug called Premarin, which was a horrendous estrogen that was very strong and very dangerous.

And I was on that drug during the time when they were doing most research to find out how dangerous it was, and eventually, it was stopped, and called back, and it couldn’t have it. But that hooked me in the need for estrogen in my body, having had my ovaries removed, and took me 10 years to wean off, and to get on to something natural.

And it was during that journey of realizing I had to take back my own health. I had to treat myself. I did all kinds of different diets, and all these different ways because my endometriosis came back. Premarin is an estrogen, which feeds endometriosis, and I had microscopic endometriosis on the intestines, and so on.

So, anyway, long story short, my own journey to finding my health, my power in my own health, recognizing I had to go outside of the medical field. Led me back to okay, then I’m going to fight. I wanted to be a midwife since I was 16. Why have I let that go just because I’m on this particular body of land. And so, I started researching.

And that’s when I got even more upset because I learned about the grand midwives, the so-called granny midwives. I learned about midwifery during slavery. I learned about indigenous midwives. I learned about the immigrant midwives, who moved to the United States with their communities, and serve their communities until such time as there was a push in the early 20th century to eradicate midwifery.

And it was successful. And so, in Florida, I realized that there were thousands of midwives, and they were gone. And it was on purpose. And so, I became really keen to see how we could change that. And I was blessed to have a midwife colleague, because there had been some licensure in Florida for a while, and then had been closed down in the 1980s.

But some of the remaining midwives have been grandmothered in, and they would continue. So, these were the midwives who had been previously licensed under Florida statute to practice for home birth and birth center. I was lucky enough to work with one midwife who she was delivering the daughter of the then, Governor of the State of Florida.

And so, I had access for the first time to talk to her and to her father, who helped me. And we found that there was a statute that still remained that said a foreign trained midwife could be issued a temporary license to practice in areas of critical need. And that was how I got it done. And so, I became the first foreign trained midwife in Florida.

And I was able to go out to three county area, which is very rural, and very poor, and begin practice there. And through that, I was able to get a full license as a licensed midwife. I was never able to do nurse midwifery, and I didn’t want to at that time anyway, so I became a licensed midwife. And through that, I started doing home birth.

And what I noticed with my home birth practice was I was working with mostly white middle class fundamental Christian women, women who were homeschooling, homesteading, living out in the woods. They weren’t too keen to be part of the mainstream, and they became my clients. And I learned so much from them. It was just like England, once again, I was being taught, and encouraged, and mentored by the women I was serving.

But I was just surprised, again, that I couldn’t encourage any people of color, women of color to come onboard, and to have a home birth. And yet, the history said that all the African-American community had for so long, until their midwives are gone. So, then I said, “Well, I would rather do something than nothing. Because if they’re not coming for homebirth, what would serve them? What would support them?”

Sure enough, it was just providing prenatal care. And so, I have to move over because I had to let go, “Well, you don’t have to be the one. It’s always not about you.” I was always caught up in the birth itself. All of the work was for the birth itself. We’re going to have this beautiful, intact perineum, and it’s going to be this amazing experience, and we’re all going to just kumbaya way through it.

And what I noticed was that people weren’t interested in that. People were interested in surviving. The questions I would hear, especially from the young women would be, “Miss Jennie, if you have to choose between my life and the baby’s life, who would you choose?” I’ve never heard of such questions. These don’t belong to midwifery. These questions don’t go together.

But this woman I was dealing with, they didn’t have midwifery as a background, they have obstetricians. And as I began to understand, they were literally telling me what was going on, which is that was the situation they were facing. They may not survive a pregnancy or their child may not survive. So, we work from the angle of we’ll provide the prenatal care.

Hand over to the physician for delivery because that’s where you feel safe. That’s where you want to be. That’s what you know. And we build a practice from there. And it was really interesting because women would call in early labor, and I think it’s time, and I’m going to the hospital now, and the encouragement to, “Yes, off you go, you’re going to be great, don’t worry, everything’s in place, your charts are already there.”

Happy, they were thrilled, they felt confident to be able to go in, and fend for themselves. And sure enough, we began to see the statistics were reflective of that. We’ve always run at least a 10% lower C-section rate than everybody else in the area, always.

Rebecca Dekker:

Even with your clients that go to the hospital?

Jennie Joseph:

All the clients I’m talking about, the client choose hospital, not the birth center, all these things-

Rebecca Dekker:

They don’t even have a midwife in the hospital. They’re just getting prenatal care with you. They go to all the OBs, and it lowers their C-section rate just having had that prenatal care.

Jennie Joseph:

Because they come in with a clue, but also what they did, and this took us a little bit of time because I’ve worked really hard to build my collaborations. I’ve made a big effort to really be in relationship with the hospitalist, with the residents, with the charged nurses. I so much humble pie, I could choke. Just meeting, and greeting, and listening to all the blah-blah-blah, and all the fear, and the drama.

And understanding their perspective, even though it didn’t make sense to me, it was real to them. And once they felt that they could trust me that I wasn’t trying to bring train wrecks to the hospital, that I wasn’t out there doing craziness, they’ve become. And also, it was as if my taking care of women that marginalized was then allowing them to not have to take on the burden, if you will, the liability-

Rebecca Dekker:

Of the prenatal care.

Jennie Joseph:

Of any of it because the main way of thinking and being implicitly or explicitly is, this is a problem. I’m going to lose my license. I’m going to lose some money behind this. I’m going to some time. I’m going to be put out. This person, because of who she looks like she might be, I’m going to judge her and assume that I’m going to have to work hard or do different, better, something, and I don’t want to do. I don’t have to.

Jennie Joseph:

I’m not even getting paid enough. All of these things that get in the middle of just being able to relate to a fellow human being and provide care. Deeply embedded racism that is not even recognized sometimes, but very much often is recognized, and is overt, and explicit, and is again condoned. I use that word a lot because it’s important that we recognize this all doesn’t happen in abstract.

Rebecca Dekker:

Nobody’s speaking up, even though it’s obvious.

Jennie Joseph:

This happens because we agree that that’s okay. Oh, I don’t want to lose my job. Of course, you don’t want to lose your job. Why would anybody want to lose their job? But don’t you want to think about the fact that your job is dependent on you to pin it up, turning a blind eye acting like that’s okay. This is what has killed and harmed women, marginalized folk for decades.

That it’s not about hemorrhage. Okay. I’m just going to say it out loud. It’s not about shoulder dystocia. It’s not about, “Oh, your blood pressure’s too high.” It’s about we don’t care. We can’t be bothered. We have a different way of doing it for you than we have for somebody else. Our hemorrhage cart is further down the hall when it’s your turn, or we’re not even going to go get it.

That’s what it’s about. That’s the bottom line. It isn’t about well, something wrong with your physiology, something wrong with your genetic makeup. Oh my gosh, if you only ate right, you wouldn’t be in these dire straits. We know all of this is absolutely not the truth. Blame the woman approach is so handy and allows us to continue to condone this desperate behavior.

This inhumanity in plain sight, written into ways of being policies are written around it, structural ways of handling it based on oh, insurance, based on indigence, based on immigration status, based on color, based on ethnicity, based on your gender identification, based on any number of arbitrary things that we’ve just collectively all agreed need to be addressed in this way, or will be addressed in this way, and no one is going to say anything about it.

And how we know that that’s true. Because many folks when I speak, they’ll jump right to, “No, no, I always speak up, or no, no, I wouldn’t put up with that, oh, no, no, I don’t see color. Oh, no, no, no.” All right, well, where are the statistics coming from? They don’t lie. The only reason they’re so bad is because we just now started looking.

It’s not like they were better before. And now, they, Well, they actually were better before, but not much better. They were still horrendous. So, we have no real excuse other than we have allowed this because this is how we do much of everything, not just medical. This is the nonprofit industrial complex.

Rebecca Dekker:

I know. And it always amazes me that hospitals are able to present themselves as nonprofit organizations because having worked in hospitals, you see the money goes to the administrators, and to the billing to make it more beautiful, and to create these astronomically high salaries for typically, the white men at the top. And people think hospitals are these nonprofits, they hold fundraisers for them. One of the most popular fundraisers in my town is for the Children’s Hospital.

Jennie Joseph:

Yeah. Particularly, children’s hospitals. Yeah.

Rebecca Dekker:

Yeah. And I don’t think most people realize that even though they’re technically nonprofits, they make a lot of money for a certain number of people.

Jennie Joseph:

Well, then, again, to attract the people with the insurance that will pay better for the same work, the same procedures, the rush to be named, the accolades that come with being one of the best, whatever that might mean. Because how you get to be the best even when you’ve got people who are dying or harmed, who have morbidity that is off the charts.

And your statistics are outrageous, but you’re still one of the best. That happens quite frequently because, again, we’re all agreeing and buying into these different things that have really nothing to do with your health, anyone’s health. So, here comes a pandemic, and it’s the great leveler. And then, there’s the oh, now that I might need or, my family might need, or my loved ones might need certain things.

Now, we might look with a little bit more of a jaundiced eye at what exactly is the system? How is it fair? How is it right? How are we seeing these disparities? So blatantly right there, once again, when it levels us all at the same point, where we all have to stop and think a minute because it could be us right now, anytime soon. It brings us to realizing that something is quite broken here.

And that’s not a good look. It’s not something that all of us on mass want to face because if we’re not in one of those marginalized groups, or we don’t care about one of those marginalized groups, then it really is easier to just keep your blinkers on and keep moving. So, I would say over the last 10 years, much more embedded into providing clinic-based work than birth center work.

I don’t do home births anymore at all because the birth center grew out of the massive home birth practice that ensued after I opened up the clinic concept, and after I was willing to provide the same care to everybody, as long as they chose where they wanted to deliver, whether it’s hospital birth center.

So, the clinic now over the course of time, we know we service hundreds of women, not all of them are black. Not all of them are marginalized. But most of them have no qualms or compunction other than to be delivering in the hospital because that’s what they know.

That’s an area where the medical industrial complex has truly done its job because even with knowledge and support, women are still choosing a hospital birth knowing the odds for the risks that could ensue, knowing how much of a chance there is that they may end up with a surgery that might not be necessary, knowing that there’s an increased chance that they may bleed, knowing that they may have to have Pitocin augmentation.

Knowing all these things, they still choose and feel safer there. Because we have had decades of indoctrination that say that that is the safest way. So, the opposite is European hospitals, other hospitals in westernized countries where the opposite is in place. Women in England, for example, are going to commiserate with that girlfriend who says I have to see the doctor in this pregnancy.

“Oh, you poor love. I’m so sorry for you. Don’t be scared, you’ll be okay.” Because normal folk has seen the midwife, and the midwife is the hospital. The midwife is running the hospital. The midwife is running the floors. The midwife is doing community birth. The midwife is doing community clinics. The midwife is doing postpartum home visits.

The midwife is liaising with the home visiting nurses. The midwife liaises with the school nurse. Midwife liaises with the general practitioner. Midwife is maternity. So, something happened here in the United States that twisted that, obviously, the eradication of the community midwives was the place where it all started, especially for communities of color, Indigenous communities, as well.

But even in the dominant culture communities, things are so messed up that we have to have these movements for women to learn about power and birth. We have to have these movements to push physiological birth. This is how upside down this is.

And while we’re staying with our movements, and our push towards empowered birth, and evidence based, and all of these things, we still left behind the people who also need the same information, support, and encouragement to break the system wide open, burn it down, as far as I’m concerned because it’s lethal.

Rebecca Dekker:

It’s literally killing people. The way it works.

Jennie Joseph:

Yes. Yes. So, what a dilemma? What a dilemma?

Rebecca Dekker:

I’ve read the research in the papers that show how the method you’ve developed, The JJ Way®, can eliminate disparities, or greatly reduce them, including the preterm birth rate, and other statistics. Can you tell our audience how does The JJ Way® work? And then, also how practitioners can get trained in it?

Jennie Joseph:

Yeah. It’s a real conundrum for me because first of all, I made up this really hokey name. I had no real thoughts about the name. I just threw that together. Now, it’s stuck. So, I’m Jennie Joseph, The JJ Way®. It’s really just silliness. But the other piece that’s really difficult is that I can and do train for the folk, but also, I really have to say out loud before someone else says it for me. The JJ Way® is a midwifery model of care. That’s it.

Rebecca Dekker:

The midwifery-led model though, correct, where the midwife is leading the team?

Jennie Joseph:

Not necessarily. You see, that midwifery model in the sense of midwives, just breaking it down to the bottom line, midwife means mid-woman. That’s it. So, it’s not midwife centric care. A lot of American midwife, midwife centric. A lot of doula work is doula centric, in my opinion.

Meaning, it’s all about what the midwife wants to suggest, and what the midwife wants to offer, and what the midwife, midwife, midwife. And the couple get to halfway almost be centered, but not quite, because it’s all about, we’re really heavy into it needs to be this way, it needs to be that way.

Rebecca Dekker:

This is the way we do things.

Jennie Joseph:

Yeah. And the birth plan has to… there’s a lot of back and forth manipulations to maybe cajole and educate you up to the hilt so you buy in. It’s almost cultish, and I’m a midwife, so please. I’m a little bit naughty here and that I’m speaking about my profession that I’ve just finished telling you. I’ve been involved in 40 years. But I recognized about myself for example, letting go of delivering the baby was a big thing, because I’m so midwife centric. Midwives, we have egos. We can’t help ourselves.

Rebecca Dekker:

So, letting go of doing the actual delivery and instead, just doing the prenatal and postpartum care?

Jennie Joseph:

Yeah. That was a big deal because I want it to be the one. I was upset for many years. I couldn’t get hospital privileges. Now, you couldn’t pay me to be in a hospital, to be anywhere near that. Because if the mother has chosen what she’s chosen, she knows. She chose a burger and not a taco, so I don’t need to insert my tacos out in the middle of her burger. They don’t match.

If you can get to that pure, authentic midwife model, it’s simply is the mother, woman, family is centered. Mother, baby, family is in the center, and then whatever it is they want or need, the midwife can supply. So, The JJ Way® has four tenets that hold it together. The model is based on access first, access to whatever it is that woman or that family are looking for.

They articulate what that is, and I want to provide access to it. So, access. Secondly, connections because once they have access, they will connect with you, they will trust you. Because for the first time, maybe someone’s listening to what they say they want, rather than telling them. In the connection, and in the trust, then you get a little bit more of a relief of angst, stress, pain.

And you begin to get real authentic conversations that can truly people disclose what’s going on for real. People are more willing to listen to the advice you might give, and are going to be more compliant because there’s trust. So, after the connections are made and strengthened, education, knowledge is easily imported.

Not everybody wants to come to Lamaze class and sit for six weeks with pillows, and huffing and puffing with their husband. Others just want a piece of information, one piece. Oftentimes it’s very broad. Am I going to be okay? Yes. All right. Child birth class is finished. That’s all the knowledge that she needed.

That’s all she was looking for. Can you assure me that I will be okay? Yes. That’s it. That’s the third one, knowledge. Fourth one is empowerment, obviously. And not only is the mother in power, but guess what, the provider is too. Because suddenly, you’re providing care in a way where you’re not all trying to commandeer everything, and be in charge of stuff, and be the small one, and knows this, that, and the other, no.

So, there’s an empowerment in being able to authentically be with somebody. Yes, you have to do some of your technical bits and pieces, obviously. You have a charge, and a scope of practice, and you’re supposed to follow those things. But obviously, everybody else is doing the same scope. They’re drawing the same labs. They’re poking the same valleys.

How come their outcomes are so wretched? Do you see? So, The JJ Way® is just a bespoke model, a twist on the midwifery model that says these other things are equally important. And so, therefore, the training I’m doing isn’t here’s how you technically measure the uterus better, or here’s how you hear the heartbeat, and discern X, Y, and Z foible.

No, it’s here’s how you step aside a minute, get out of the way, and look at what you can do to support, and fill in blanks, and gaps, where there’s potentially something that you would have totally overlooked if you were working from the opposite. So, I call it a gap management model, both provider and patient, where are the gaps?

What don’t you know that you need to know to be able to get to the other side of this? What technique would work for this particular couple, which wouldn’t work for another? How do they learn? How do they hear? How do they trust? So, a lot of it is also navigation. The onus was on me, and my staff to learn, and understand, like I said, we went and made the effort for the collaborative care.

We didn’t just say go on up there, and they’ll take care of you. No, we’re not sending sheep to the slaughter. We had to know that if they got there, they would be taken care of. We had to go and work with the staff where they were to understand what they needed. JJ Way® works for both sides. The staff needed access to what we were doing to understand what we were doing to not be scared of what we were doing, and to recognize, “Oh, this isn’t what you were taught.

We thought you’re talking about home birth? No, I’m not talking about home birth. Okay, let’s talk.” So, JJ Way® is finding tools, and avenues, opportunities to craft individualized care every time, be open to the need for the patient, woman, client, family led care, to step aside and move out of the way so that the full empowerment can come into play.

So, to this day, Rebecca, I cannot explain to you how come we’ve dropped our C-section rate to 20%, 25% every year without any midwife. And sometimes, not even a doula setting foot in the hospital with these women, who left alone would be among the others getting 35%, 40% cut because that’s what happens.

So, what is it? We don’t do a C-section class. We don’t even do a VBAC class. What is it? The husbands don’t get tossed out the door. They’re not calling security every five minutes. The women don’t have a birth plan that’s written out and ready to go. They’re not taking lavender. What is it? So, they have an understanding from inception, from the access point.

It doesn’t matter what Medicaid you got, come on, we’ll figure it out. We have to get you seen. We want to get you started. We’ll help you find a way to get on that Medicaid, or to get that managed care plan, or to get your insurance to reduce the stupid deductible, or we’ll figure a way. We are here to make sure so your access is guaranteed. From there, there’s a sigh of relief. There’re tears. There’s a breakdown of, “Oh, are you kidding?”

Rebecca Dekker:

Yeah. How much of a stress leading to the increase in preterm birth, especially in the black community, do you think is iatrogenic caused by the medical system itself encounters during pregnancy?

Jennie Joseph:

All of it. Because affluent black women, college-educated black women, celebrity is not protected. Serena Williams. Come on now, what else could it be? Imagine you have to be so alert and aware to advocate for your own life in a stinking hospital.

Rebecca Dekker:

So, what you’re doing is providing access, a trusting relationship, education, and support, and you’re taking away that anxiety. You’re also providing culturally safe care, so they feel safe with you.

Jennie Joseph:

Well, culturally, yeah, we do have a clinic, Spanish language clinic, and a Portuguese language clinic. But we’re speaking English with African-American clients, and English-speaking folk. But what we know is the culture is not necessarily just the literal language or the ethnicity, the culture is.

 

We are going to acknowledge and agree with you that something is very wrong, something smells bad. The congruence in that is that we know it because we feel it too. We live it, but that doesn’t mean that somebody who doesn’t it can’t have that humility. And the humility isn’t again about Look at me coming in to save the day, the humility is about you are not wrong.

Rebecca Dekker:

It’s about believing then.

Jennie Joseph:

I am not one with the cognitive dissonance here, saying that no, everything’s lovely. It’s just you. If you don’t need change your diet, we wouldn’t have a problem. With the acknowledgment, which is also part of knowledge, then the learning can begin because you have to hear the individual’s story and situation to truly be able to support.

And if they’re not going to tell you because they don’t trust you, because you aren’t safe, then they have to hold that. So, a flip side, the opposite answer to the same question is, what is it physiologically that locks the cervix that up to now before having come to our clinic, or our service, or to the other community-led programs around this country, which are doing the same work, and doing the same outcomes.

What is it physiologically that has your cervix hold when two, three other pregnancies before your baby fell out at 28 weeks? One of the biggest dilemmas and complaints of my clients is at 40 weeks, get this baby. “Miss Jennie, I can’t do another day. Can you help? I’ve got to get-“

Rebecca Dekker:

They’re all going to term and all going to their due date.

Jennie Joseph:

Okay. Now, somebody, there’s going to be some ruckus up in here if you don’t help me get this child born. Because the hospitalist won’t deliver my patients, they won’t induce them, they won’t touch them with a 10-foot pole. Why? Because the imbedded ways of being the racism and classism it goes with, well, “You’re not insured. You’re not with a private provider. You belong with those folks from the health department, those folks from the community clinics. So, no, you’re not getting induction. Who do you think you are? We’re not going to service you until you show up heavy in labor. So, go away. We’re not going to admit you at three centimeters because we just don’t feel like it.”

“We’re going to make you walk outside until you’re screaming, and then maybe, we’ll see if we can get you on the bed and off the bed quickly.” That’s the policy. That’s not somebody having a bad day. Charge nurse is on her period and she feels like being mean. No, that is the policy. What insurance does she have? Okay, we’ll do this, this and that. Oh, what insurance?

Oh, we’ll do the other thing. That’s lethal too. The nurses are really in a dilemma. The nurses are delivering America without any support, any recognition, any understanding, anybody coming to save the day, no one is coming. The physicians want to hold on to the old ways of doing things, where they can pop in when the head is coming out, get their money and keep it moving.

The risk managers are trying to build a hospital conglomerates with their billion-dollar systems. Nobody wins. Midwifery is not the answer. The handful of folks that will stay out of the hospital, they’re fine, nothing wrong with them. There aren’t enough of them, and there are enough midwives. So, here we are, what a dilemma.

Rebecca Dekker:

Where do we go from here? With our last few minutes with you, I’d love for you to maybe speak, I know you work with a lot of midwifery students. So, we have a lot of doulas who listen, a lot of students, a lot of nurses who want to become midwives. Maybe you could give some words of wisdom or advice to the future midwives who are listening right now?

Jennie Joseph:

Yes. I think first of all, get yourself a reality check if you haven’t yet. It is a lot of work and energy to be I’m going to just get this degree, or this piece of paper, and run out, and save the day. Let’s start looking at what we’re actually up against so that we are really clear. This work is going to be a slow process. This is generational work.

It took generations to dismantle midwifery. It will take generations to rebuild it. But we can get into action now. We have to be clear about what we’re up against. We have to stop blaming the women. Even though we look like, and think like, we’re not really blaming them. We still are. We throw our hands up when they don’t listen to our ideas about why don’t you have a home birth, or why don’t you stay at the birth center?

We feel annoyed that they won’t listen, and be educated quickly enough into changing their birth plan. Or we’re upset when halfway through a labor at a birth center they can’t handle, and they want to go in. This is our work. This is our midwifery work. This is for us to understand, there’s other ways to midwife than the traditional looking way until we get to the point of critical mass.

Until we get enough people to understand that midwifery model could be an opportunity, an alternative. So, we considered midwifery when COVID was rampant because suddenly, it was like, “Well, what else are we going to do?” That’s not the same thing either. What we’re going to do when COVID is not rampant?

So, we need as midwives to really think through, first of all, accept and acknowledge what we have as a system, and understand how it needs to be dismantled. But really clearly, look at ways that are practical. We need to look at how to get into policy, and change policy where hospitals are monopolizing the maternity care in the United States.

We need ways to share that burden out. Birth centers and communities need to be supported. And that’s real support. I’m not talking about here’s a little grant to try and do something for five minutes. I’m talking about just as structurally supportive as a surgical center would be put up, and supported, or as a pediatric walk in nighttime clinic would be set up and supported.

We need to have a deeper understanding of business, as well as practice. We need to understand how independently, we can get more done than joining in with a system that is not going to ever look out for what we as midwives know as the safest best way to be. So, policy, looking at legislation, looking at access through insurance, or Medicaid, looking at those kinds of deeper systemic ways for ourselves will help us.

But until we want to agree and acknowledge that the way we have a medical system set up, and the way maternity care is now, midwifery cannot break through that. We’re going to have to figure out how we do it on the outside, build critical mass, and have women choose organically, not being forced to cajoled, but choose because finally they see the light themselves.

So, doulas help us in a lot of ways because doulas are educating way more people than midwives will ever reach. And as they do that work, I think, again, generationally, we’ll begin to see more and more people recognize the power of natural birth, physiological birth. But it will happen in the hospital. It’s going to have to happen in the hospital first, because that’s where 90% of women deliver in the United States.

So, I say don’t be discouraged, but be practical. Look at your own access points. Look at your own connections. Look at your own knowledge base. Empower yourself from a place of the long-term bigger picture, move a little bit out of the center if you can. So, it’s not all about you, and your particular individual practice, but rather the bigger greater good of once again, this country being delivered by midwives.

And know that it’s not going to happen in your lifetime. I don’t see it. But let’s get going anyway. Let’s build that groundwork now. Build the baseline, keep training, and sharing. And we’ll get there together, but not maybe now during our time, so yeah, yeah.

Rebecca Dekker:

Be a good ancestor?

Jennie Joseph:

Yes, seriously.

Rebecca Dekker:

If we’re thinking about it from taking generations to make change.

Jennie Joseph:

Yeah, yes, yes.

Rebecca Dekker:

Thank you, Jennie, so much for the power that you shared with us today. And what’s the best way for people to follow your work and support what you’re doing?

Jennie Joseph:

Yeah. I’m very easily found, commonsensechildbirth.org is my main website. I got 10,000 websites and 10,000 emails. So, stop there. The offshoot is Commonsense Childbirth School of Midwifery. I have a Commonsense childbirth Institute where we train perinatal health workers. And then, I have the National Perinatal Taskforce, which is our grassroots organization to support the supporters.

Particularly, those women and men on the frontlines of reducing and eliminating disparities once and for all. So, our underlying statement with the National Perinatal Taskforce is that we are building a movement to birth in just and loving world. That’s how we see change is going to happen. And we need to be kind, and sweet, and support each other, and ourselves as we’re doing that movement. So, commonsensechildbirth.org, start there, and off you go.

Rebecca Dekker:

Thank you, Jennie, for your time.

Jennie Joseph:

Thank you, Rebecca, for having me. It was a real pleasure. Thank you so much.